CN110662505A

CN110662505A - Combined ultrasonic and electrosurgical instrument with clamp arm electrodes

Info

Publication number: CN110662505A
Application number: CN201880033752.4A
Authority: CN
Inventors: J·R·莱斯科; C·A·科贝特; C·T·戴维斯; F·L·埃斯特拉
Original assignee: Ethicon LLC
Current assignee: Ethicon LLC
Priority date: 2017-05-22
Filing date: 2018-05-21
Publication date: 2020-01-07
Also published as: JP7179774B2; US20180333177A1; WO2018217598A1; GB202209985D0; EP3634285B1; CN110678130B; MX2019013879A; MX2019013883A; JP2020520728A; GB2608896A; EP3629955A2; EP3629952A1; US10945778B2; US11129661B2; WO2019013867A1; JP7301751B2; US20210346078A1; BR112019024307A2; BR112019024331A2; PL3634274T3

Abstract

A surgical instrument includes an ultrasonic transducer, a distally extending shaft, and an end effector at a distal end of the shaft. The end effector includes an ultrasonic blade and a clamp arm. The ultrasonic blade includes an upper treatment side, a lower treatment side, a first lateral side, and a second lateral side. The clamp arm is movable relative to the ultrasonic blade for clamping tissue therebetween, and the clamp arm provides an RF electrode operable to seal the tissue with RF energy. The RF electrode includes a first electrode side and a second electrode side. The first electrode side is spaced laterally outward from the first lateral side of the ultrasonic blade by a first lateral gap distance. The second electrode side is spaced apart from the first electrode side and laterally outward from the second lateral side of the ultrasonic blade by a second lateral gap distance.

Description

Combined ultrasonic and electrosurgical instrument with clamp arm electrodes

The present application claims the benefit of U.S. provisional application 62/509,351 entitled "ultrasound Instrument With electronic Features" filed on 2017, 5, month 22, the disclosure of which is incorporated herein by reference.

Background

Ultrasonic surgical instruments utilize ultrasonic energy to both precisely cut and controllably coagulate tissue. The ultrasonic energy cuts and coagulates the tissue by vibrating a knife in contact with the tissue. For example, vibrating at a frequency of about 50 kilohertz (kHz), the ultrasonic blade denatures proteins in the tissue to form a viscous coagulum. Pressure applied to the tissue by the knife surface collapses the blood vessel and allows the coagulum to form a hemostatic seal. The precision of cutting and coagulation can be controlled by the surgeon's technique and adjustments to, for example, power level, blade edge, tissue traction, and blade pressure.

Examples of ultrasonic surgical devices include HARMONICUltrasonic scissors and HARMONIC

Ultrasonic scissors and HARMONIC

Ultrasonic scissors and HARMONIC

Ultrasonic blades, all of which are available from Ethicon Endo-Surgery, inc. (Cincinnati, Ohio). Other examples of such devices and related concepts are disclosed in the following patents: U.S. Pat. No. 5,322,055, entitled "Clamp Coogulator/Cutting System for ultrasonic Surgical Instruments," published 21/6/1994, the disclosure of which is incorporated herein by reference; U.S. patent 5,873,873 entitled "ultrasound Clamp Cooperator Apparatus having a wavelength improved Clamp Mechanism" published on 23.2.1999, the disclosure of which is incorporated herein by reference; U.S. patent 5,980,510 entitled "ultrasound Clamp Cooperator Apparatus having a wavelength improved Clamp Arm Pivot Mount" published on 9.11.1999, the disclosure of which is incorporated herein by reference; U.S. Pat. No.6,283,981 entitled "Method of Balancing Asymmetric ultrasonicSurgical Blades" published on 9, 4.2001, the disclosure of which is incorporated herein by reference; U.S. Pat. No.6,309,400, entitled "cultured Ultrasonic Blade lifting a transporting Cross Section," published 2001, 10, 30, and the disclosure of which is incorporated herein by reference; U.S. Pat. No.6,325,811, entitled "Blades with Functional Balance instruments for use with Ultrasonic surgical instruments", published 12, 4.2001, the disclosure of which is incorporated herein by reference; U.S. patent 6,423,082 entitled "Ultrasonic Surgical Blade with Improved Cutting and modeling efficiencies" published 2002, 7, 23, the disclosure of which is incorporated herein by reference; U.S. Pat. No.6,773,444 entitled "Blades with Functional Balance Instruments for Use with ultrasonic surgical Instruments" published on 8/10 2004, the disclosure of which is incorporated herein by reference; U.S. Pat. No.6,783,524, published at 31/8/2004, entitled "fibrous Tool with ultrasonic catalysis and measuring Instrument," the disclosure of which is incorporated herein by reference; U.S. patent 8,057,498 entitled "Ultrasonic Surgical instruments Blades" published on 15.11.2011, the disclosure of which is incorporated herein by reference; U.S. Pat. No.8,461,744 entitled "Rolling Transducer Mount for Ultrasonic Surgical Instruments" published on 6/11/2013, the disclosure of which is incorporated herein by referenceThe formula (I) is incorporated herein; U.S. patent 8,591,536 entitled "Ultrasonic Surgical instruments" published on 26.11.2013, the disclosure of which is incorporated herein by reference; U.S. patent 8,623,027 entitled "Ergonomic scientific Instruments" published on 7.1.2014, the disclosure of which is incorporated herein by reference; U.S. patent 9,095,367 entitled "Flexible Harmonic Waveguides/Blades for surgical Instruments" published on 4.8.2015, the disclosure of which is incorporated herein by reference; and U.S. publication 2016/0022305 entitled "Ultrasonic Blade over" published on 28.1.2016, the disclosure of which is incorporated herein by reference.

Electrosurgical instruments seal tissue with electrical energy and typically include a distally mounted end effector that may be configured for bipolar or monopolar operation. During bipolar operation, current is provided through the tissue through the active and return electrodes of the end effector. During monopolar operation, current is provided through the tissue through an active electrode of the end effector and a return electrode (e.g., a ground pad) separately disposed on the patient's body. The heat generated by the current flowing through the tissue may form a hemostatic seal within and/or between the tissues, and thus may be particularly useful, for example, in sealing blood vessels. The end effector of the electrosurgical device may also include a cutting member movable relative to the tissue and an electrode to transect the tissue.

Electrical energy applied by the electrosurgical device may be transmitted to the instrument by a generator coupled to the instrument. The electrical energy may be in the form of radio frequency ("RF") energy, which is typically in the frequency range of about 300 kilohertz (kHz) to 1 megahertz (MHz). In use, the electrosurgical device may deliver lower frequency radiofrequency energy through tissue, which may cause ionic oscillations or friction and, in effect, resistive heating, thereby raising the temperature of the tissue. Because a sharp boundary is formed between the affected tissue and the surrounding tissue, the surgeon is able to operate with high precision and control without damaging adjacent non-target tissue. The low operating temperature of the RF energy may be suitable for removing soft tissue, contracting soft tissue, or sculpting soft tissue while sealing the vessel. RF energy is particularly effective for connective tissue, which is composed primarily of collagen and contracts when exposed to heat.

An example of a radio frequency electrosurgical device is manufactured by Ethicon Endo-Surgery, Inc (Cincinnati, Ohio)

A tissue sealing device. Other examples of electrosurgical devices and related concepts are disclosed in the following U.S. patents: U.S. Pat. No.6,500,176, entitled "Electrical Systems and Techniques for sealing Tissue," published at 12.31, 2002, the disclosure of which is incorporated herein by reference; U.S. patent No.7,112,201 entitled "Electrical Instrument and Method of Use" published on 26.9.2006, the disclosure of which is incorporated herein by reference; U.S. Pat. No.7,125,409 entitled "Electrical Working End for Controlled Energy Delivery" published 24.10.2006, the disclosure of which is incorporated herein by reference; U.S. Pat. No.7,169,146 entitled "Electrosurgical Probe and Method of Use" published on 30.1.2007, the disclosure of which is incorporated herein by reference; U.S. Pat. No.7,186,253 entitled "Electrical Jaw Structure for Controlled Energy Delivery" published on 6.3.2007, the disclosure of which is incorporated herein by reference; U.S. patent No.7,189,233 entitled "electrical Instrument" published 3-13.2007, the disclosure of which is incorporated herein by reference; U.S. patent 7,220,951 entitled "scientific Sealing Surfaces and Methods of Use" published on 22.5.2007, the disclosure of which is incorporated herein by reference; U.S. patent No.7,309,849, entitled "Polymer compositions exhibiting A PTC Property and Methods of Fabric", published on 18.12.2007, the disclosure of which is incorporated herein by reference; U.S. Pat. No.7,311,709 entitled "Electrosurgical Instrument and Method of Use" published on 25.12.2007, the disclosure of which is incorporated herein by referenceIncorporated herein by way of reference; U.S. patent No.7,354,440 entitled "electrical Instrument and Method of use" published on 8.4.2008, the disclosure of which is incorporated herein by reference; U.S. patent No.7,381,209 entitled "electrical Instrument" published on 3.6.2008, the disclosure of which is incorporated herein by reference.

Other examples of electrosurgical devices and related concepts are disclosed in the following U.S. patents: U.S. Pat. No.8,939,974 entitled "scientific Instrument sharing First and Second Drive System saw able by a Common Trigger Mechanism," published 27/1/2015, the disclosure of which is incorporated herein by reference; U.S. patent No.9,161,803 entitled "Motor driven electrochemical Device with Mechanical and Electrical Feedback" published 10/20/2015, the disclosure of which is incorporated herein by reference; U.S. publication No.2012/0078243 entitled "Control Features for insulating scientific Device" published 3/29 2012, the disclosure of which is incorporated herein by reference; U.S. Pat. No.9,402,682 entitled "engineering joints for engineering Surgical devices" published on 8/2 2016, the disclosure of which is incorporated herein by reference; U.S. patent No.9,089,327 entitled "scientific Instrument with Multi-Phase Trigger Bias" published on 28.7.2015, the disclosure of which is incorporated herein by reference; U.S. patent No.9,545,253 entitled "scientific Instrument with Contained Dual helium actuatoralssably" published on 17.1.2017, the disclosure of which is incorporated herein by reference; and U.S. patent No.9,572,622 entitled "Bipolar electric catalysts for Targeted Hemostasis" published on 21.2.2017, the disclosure of which is incorporated herein by reference.

Some instruments may provide both ultrasonic and RF energy processing capabilities through a single surgical device. Examples of such devices and related methods and concepts are disclosed in the following patents: U.S. patent 8,663,220 entitled "Ultrasonic surgical instruments" published 3,4, 2014, the disclosure of which is incorporated herein by reference; U.S. publication 2015/0141981 entitled "Ultrasonic Surgical Instrument with Electrical Feature" published 5/21/2015, the disclosure of which is incorporated herein by reference; and U.S. publication 2017/0000541 entitled "scientific Instrument with User adaptive Techniques" published on 5.1.2017, the disclosure of which is incorporated herein by reference.

While various types of ultrasonic and electrosurgical instruments have been made and used, it is believed that no one prior to the inventors has made or used the invention described herein.

Drawings

The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate embodiments of the invention and, together with a general description of the invention given above, and the detailed description of the embodiments given below, serve to explain the principles of the invention.

FIG. 1 depicts a perspective view of an exemplary surgical system having a generator and a surgical instrument operable to treat tissue with ultrasonic energy and bipolar RF energy;

FIG. 2 depicts a top perspective view of an end effector of the surgical instrument of FIG. 1 having a clamp arm providing a first electrode and an ultrasonic blade providing a second electrode;

FIG. 3 depicts a bottom perspective view of the end effector of FIG. 2;

FIG. 4 depicts a partially exploded perspective view of the surgical instrument of FIG. 1;

FIG. 5 depicts an enlarged exploded perspective view of a distal portion of a shaft assembly and an end effector of the surgical instrument of FIG. 1;

FIG. 6 depicts a side elevational view of a distal portion of an inner tube of the shaft assembly of the surgical instrument of FIG. 1;

FIG. 7 depicts a perspective view of a distal portion of an ultrasonic blade and shaft assembly of the surgical instrument of FIG. 1 with the clamp arm hidden from view;

FIG. 8 depicts a top elevation view of a distal portion of the ultrasonic blade and shaft assembly of FIG. 7;

FIG. 9 depicts a cross-sectional view of the ultrasonic blade of FIG. 7 taken along section line 9-9 of FIG. 8;

FIG. 10 depicts a schematic cross-sectional end view of an end effector of the surgical instrument of FIG. 1 showing a clamp arm having a clamp pad and first and second electrode portions on either side of the clamp pad, indicating a lateral width of each electrode portion and a side gap distance between each electrode portion and a respective lateral side of an ultrasonic blade;

FIG. 11 depicts a bottom elevation view of an exemplary variation of the end effector of FIG. 10 including a clamp arm having first and second electrode portions that each maintain a uniform lateral width and a uniform side gap distance along a tissue treatment portion of an ultrasonic blade;

FIG. 12 depicts a bottom elevation view of another exemplary variation of the end effector of FIG. 10 including a clamp arm having first and second electrode portions that each maintain a uniform lateral width and a distally increasing non-uniform side gap distance;

FIG. 13 depicts a bottom elevation view of another exemplary variation of the end effector of FIG. 10 including a clamp arm having first and second electrode portions with distally increasing non-uniform lateral widths and distally increasing non-uniform side gap distances; and is

FIG. 14 depicts a bottom elevation view of another exemplary variation of the end effector of FIG. 10 including a clamp arm having first and second electrode portions with distal ends that are spaced apart from each other.

The figures are not intended to be limiting in any way and it is contemplated that various embodiments of the invention may be carried out in a variety of other ways, including those not necessarily shown in the figures. The accompanying drawings incorporated in and forming a part of the specification illustrate several aspects of the present invention and, together with the description, serve to explain the principles of the invention; it should be understood, however, that the invention is not limited to the precise arrangements shown.

Detailed Description

The following description of certain examples of the invention should not be used to limit the scope of the invention. Other examples, features, aspects, embodiments and advantages of the invention will become apparent to those skilled in the art from the following description, which is given by way of illustration, one of the best modes contemplated for carrying out the invention. As will be realized, the invention is capable of other different and obvious aspects, all without departing from the invention. Accordingly, the drawings and description are to be regarded as illustrative in nature and not as restrictive.

For clarity of disclosure, the terms "proximal" and "distal" are defined herein with respect to a surgeon or other operator grasping a surgical instrument having a distal surgical end effector. The term "proximal" refers to a position of an element that is disposed closer to a surgeon, and the term "distal" refers to a position of an element that is disposed closer to a surgical end effector of a surgical instrument and further from a surgeon. Furthermore, to the extent that spatial terms such as "upper," "lower," "vertical," "horizontal," and the like are used herein with reference to the drawings, it is to be understood that such terms are used for exemplary descriptive purposes only and are not intended to be limiting or absolute. In this regard, it should be understood that surgical instruments, such as those disclosed herein, may be used in a variety of orientations and positions not limited to those shown and described herein.

I. Exemplary surgical System

Fig. 1 depicts an exemplary surgical system (10) including a generator (12) and a surgical instrument (14). The surgical instrument (14) is operatively coupled with the generator (12) via a power cable (16). As described in greater detail below, the generator (12) is operable to power the surgical instrument (14) to deliver ultrasonic energy for cutting tissue and electrosurgical bipolar RF energy (i.e., therapeutic levels of RF energy) for sealing tissue. In an exemplary configuration, the generator (12) is configured to power a surgical instrument (14) to deliver ultrasonic energy and electrosurgical bipolar RF energy simultaneously.

A. Overview of an exemplary surgical instrument having ultrasonic and electrosurgical features

The surgical instrument (14) of the present example includes a handle assembly (18), a shaft assembly (20) extending distally from the handle assembly (18), and an end effector (22) disposed at a distal end of the shaft assembly (20). The handle assembly (18) includes a body (24) including a pistol grip (26) and energy control buttons (28, 30) configured to be manipulated by a surgeon. A trigger (32) is coupled to a lower portion of the body (24) and is pivotable toward and away from the pistol grip (26) to selectively actuate the end effector (22), as described in greater detail below. For example, in other suitable variations of the surgical instrument (14), the handle assembly (18) may include a scissor grip configuration. As described in more detail below, the ultrasonic transducer (34) is housed inside the body (24) and is supported by the body (24). In other configurations, the ultrasound transducer (34) may be disposed outside of the body (24).

As shown in fig. 2 and 3, the end effector (22) includes an ultrasonic blade (36) and a clamp arm (38) configured to selectively pivot toward and away from the ultrasonic blade (36) for clamping tissue therebetween. The ultrasonic blade (36) is acoustically coupled with an ultrasonic transducer (34) configured to drive (i.e., vibrate) the ultrasonic blade (36) at an ultrasonic frequency for cutting and/or sealing tissue positioned in contact with the ultrasonic blade (36). The clamp arm (38) is operatively coupled with the trigger (32) such that the clamp arm (38) is configured to pivot toward the ultrasonic blade (36) to a closed position in response to pivoting of the trigger (32) toward the pistol grip (26). Additionally, the clamp arm (38) is configured to pivot away from the ultrasonic blade (36) to an open position (see, e.g., fig. 1-3) in response to pivoting of the trigger (32) away from the pistol grip (26). Various suitable ways in which the clamp arm (38) may be coupled with the trigger (32) will be apparent to those of ordinary skill in the art in view of the teachings provided herein. In some variations, one or more resilient members may be incorporated to bias the clamp arm (38) and/or trigger (32) toward the open position.

A clamp pad (40) is secured to and extends distally along a clamp side of the clamp arm (38) so as to face the ultrasonic blade (36). The clamp pad (40) is configured to engage and clamp tissue against a corresponding tissue treatment portion of the ultrasonic blade (36) when the clamp arm (38) is actuated to its closed position. At least the clamping side of the clamping arm (38) provides a first electrode (42), referred to herein as the clamping arm electrode (42). In addition, at least the clamping side of the ultrasonic blade (36) provides a second electrode (44), referred to herein as a blade electrode (44). As described in greater detail below, the electrodes (42, 44) are configured to apply electrosurgical bipolar RF energy provided by the generator (12) to tissue electrically coupled with the electrodes (42, 44). The clamping arm electrode (42) may be used as an active electrode and the knife electrode (44) as a return electrode, or vice versa. The surgical instrument (14) may be configured to apply electrosurgical bipolar RF energy through the electrodes (42, 44) while vibrating the ultrasonic blade (36) at the ultrasonic frequency, before vibrating the ultrasonic blade (36) at the ultrasonic frequency and/or after vibrating the ultrasonic blade (36) at the ultrasonic frequency.

As shown in fig. 1-5, the shaft assembly (20) extends along a longitudinal axis and includes an outer tube (46), an inner tube (48) received within the outer tube (46), and an ultrasonic waveguide (50) supported within the inner tube (48). As best seen in fig. 2-5, a clamp arm (38) is coupled to the distal ends of the outer and inner tubes (46, 48). Specifically, the clamp arm (38) includes a pair of proximally extending clevis arms (52) that receive a distal end (54) of the inner tube (48) therebetween and are pivotably coupled to the distal end (54), with a pivot pin (56) received within a through-hole formed in the clevis arms (52) and the distal end (54) of the inner tube (48). First and second connecting fingers (58) depend downwardly from the connecting prongs (52) and are pivotably coupled to a distal end (60) of the outer tube (46). Specifically, each connecting finger (58) includes a projection (62) that is rotatably received within a corresponding opening (64) formed in a sidewall of a distal end (60) of the outer tube (46).

In the present example, the inner tube (48) is longitudinally fixed relative to the handle assembly (18), and the outer tube (46) is configured to translate relative to the inner tube (48) and the handle assembly (18) along a longitudinal axis of the shaft assembly (20). As the outer tube (46) translates distally, the clamp arm (38) pivots about the pivot pin (56) toward its open position. As the outer tube (46) translates proximally, the clamp arms (38) pivot in opposite directions toward their closed position. A proximal end of the outer tube (46) is operatively coupled with the trigger (32), such as by a linkage assembly, such that actuation of the trigger (32) causes the outer tube (46) to translate relative to the inner tube (48) to open or close the clamp arm (38). In other suitable arrangements not shown herein, the outer tube (46) may be longitudinally fixed and the inner tube (48) may be configured to translate for moving the clamp arm (38) between its open and closed positions.

The shaft assembly (20) and the end effector (22) may be configured to rotate together about a longitudinal axis relative to the handle assembly (18). As shown in fig. 4, a retaining pin (66) extends transversely through the outer tube (46), the inner tube (48), and the proximal portion of the waveguide (50) to rotationally couple these components relative to one another. In the present example, a rotation knob (68) is provided at a proximal end portion of the shaft assembly (20) to facilitate rotation of the shaft assembly (20) and end effector (22) relative to the handle assembly (18). The rotation knob (68) is rotationally fixed to the shaft assembly (20) with a retaining pin (66) extending through a proximal collar of the rotation knob (68). It should be understood that in other suitable configurations, the rotation knob (68) may be omitted or replaced with an alternative rotational actuation structure.

The ultrasonic waveguide (50) is acoustically coupled at its proximal end, for example by a threaded connection, with the ultrasonic transducer (34) and at its distal end with the ultrasonic blade (36), as shown in fig. 5. The ultrasonic blade (36) is shown as being integrally formed with the waveguide (50) such that the blade (36) extends distally directly from the distal end of the waveguide (50). In this way, the waveguide (50) acoustically couples the ultrasonic transducer (34) with the ultrasonic blade (36) and serves to transmit ultrasonic mechanical vibrations from the transducer (34) to the blade (36). Thus, the ultrasonic transducer (34), the waveguide (50), and the ultrasonic blade (36) together define an acoustic assembly (100). During use, the ultrasonic blade (36) may be positioned in direct contact with tissue, applying ultrasonic vibrational energy to the tissue with or without the supplemental clamping force provided by the clamp arm (38), and thereby cutting and/or sealing the tissue. For example, the knife (36) may cut through tissue clamped between the clamp arm (38) and a first treatment side (204) of the knife (36), or the knife (36) may cut through tissue positioned in contact with an oppositely disposed second treatment side (206) of the knife (36), such as during a "back cut" movement. In some variations, the waveguide (50) may amplify the ultrasonic vibrations delivered to the blade (36). Additionally, the waveguide (50) may include various features operable to control the gain of the vibration, and/or features adapted to tune the waveguide (50) to a selected resonant frequency. Additional exemplary features of the ultrasonic blade (36) and waveguide (50) are described in more detail below.

The waveguide (50) is supported within the inner tube (48) by a plurality of nodal support elements (70) located along the length of the waveguide (50), as shown in fig. 4 and 5. In particular, the node support element (70) is positioned longitudinally along the waveguide (50) at a location corresponding to an acoustic node defined by resonant ultrasonic vibrations transmitted through the waveguide (50). The nodal support member (70) may provide structural support to the waveguide (50) and acoustic isolation between the waveguide (50) and the inner and outer tubes (46, 48) of the shaft assembly (20). In an exemplary variation, the node support element (70) may comprise an O-ring. The waveguide (50) is supported at its most distal acoustic node by a node support element in the form of an overmold member (72), as shown in fig. 5. For example, the waveguide (50) is longitudinally and rotationally fixed within the shaft assembly (20) by a retaining pin (66) that passes through a transverse through-hole (74) formed at a proximally-disposed acoustic node (such as the most proximal acoustic node) of the waveguide (50).

In this example, the distal tip (76) of the ultrasonic blade (36) is located at a position corresponding to an anti-node associated with resonant ultrasonic vibrations transmitted through the waveguide (50). Such a configuration enables the acoustic assembly (100) of the instrument (14) to be tuned to a preferred resonant frequency f when the ultrasonic blade (36) is not loaded by tissue_o. When the ultrasonic transducer (34) is operated by the generator (12) to transmit mechanical vibrations through the waveguide (50) to the blade (36), the distal tip (76) of the blade (36) is caused to vibrate at a predetermined frequency f of vibration of about 50kHz, for example_oFor example, in the range of about 20 to 120 microns peak to peak, and in some cases, in the range of about 20 to 50 microns. When the ultrasonic blade (36) is positioned in contact with tissue, the blade(36) The ultrasonic oscillations of (a) may simultaneously sever tissue and denature proteins in adjacent tissue cells to provide a coagulating effect with minimal heat diffusion.

As shown in fig. 6, the distal end (54) of the inner tube (48) may be radially outwardly offset relative to the remaining proximal portion of the inner tube (48). This configuration enables the pivot pin hole (78) that receives the clamp arm pivot pin (56) to be spaced farther from the longitudinal axis of the shaft assembly (20) than if the distal end (54) were formed flush with the remaining proximal portion of the inner tube (48). Advantageously, this provides increased clearance between the clamp arm electrode (42) and the proximal portion of the blade electrode (44), thereby mitigating the risk of undesirable "shorting" between the electrodes (42, 44) and their corresponding active and return electrical paths during a back cut as the ultrasonic blade (36) flexes toward the clamp arm (38) and pivot pin (56) in response to normal forces exerted on the blade (36) by tissue. In other words, when the ultrasonic blade (36) is used for a back cutting operation, the ultrasonic blade (36) may tend to deflect slightly away from the longitudinal axis of the shaft assembly (20) toward the pin (56). By spacing the pivot pin hole (78) farther from the longitudinal axis than if the pivot pin hole (78) would otherwise be absent the radial offset provided by the distal end (54) of the present example, the distal end (54) provides additional lateral clearance between the pivot pin (56) and the ultrasonic blade (36), thereby reducing or eliminating the risk of contact between the ultrasonic blade (36) and the pivot pin (56) as the ultrasonic blade (36) deflects laterally during a backsutting operation. In addition to preventing electrical shorting of the circuit that would otherwise be caused by contact between the ultrasonic blade (36) and the pivot pin (56) when the end effector (22) is activated to apply RF electrosurgical energy, the additional clearance prevents mechanical damage that would otherwise be caused by contact between the ultrasonic blade (36) and the pivot pin (56) when the ultrasonic blade (36) is ultrasonically vibrated.

B. Exemplary ultrasonic blade

Fig. 7-9 illustrate additional details of the ultrasonic blade (36) of the surgical instrument (14). An ultrasonic blade (36) includes a tissue treatment portion extending distally beyond the inner and outer tube distal ends (54, 60) and terminating in a distal tip (76) having rounded edges. The tissue treatment portion of the blade (36) is configured to contact and treat tissue with ultrasonic energy received through the ultrasonic waveguide (50). As shown in fig. 8, the tissue treatment portion of the knife (36) includes a proximal linear knife region (202) and a distal curved knife region (204) extending distally from the linear knife region (202). The linear blade region (202) extends parallel to a longitudinal axis along which a waveguide (50) defined by the shaft assembly (20) extends. The curved blade region (204) extends along a curved path that is laterally deflected in a distal direction away from the longitudinal axis. As best shown in fig. 8, the lateral dimension of the curved blade region (204) tapers distally toward the distal tip (76). As shown in fig. 2 and 3, the clamp arm (38) may be similar in shape to the treatment portion of the ultrasonic blade (36) in that the clamp arm (38) includes a proximal linear clamp portion and a distal curved clamp portion. In an alternative configuration, the ultrasonic blade (36) and clamp arm (38) may be entirely linear and extend parallel to the longitudinal axis.

The tissue treatment portion of the ultrasonic blade (36) includes an upper primary treatment side (206) facing the clamp arm (38) (hidden from view) and configured to compress tissue against the clamp arm (38). The tissue treatment portion further includes a lower secondary treatment side having a cutting edge (208) disposed opposite the primary treatment side (206) and facing away from the clamp arm (38). The cutting edge (208) is configured to cut tissue during a back-cut procedure. The first and second lateral blade sides (210, 212) extend between the primary processing side (206) and the cutting edge (208). As best shown in the cross-sectional view of fig. 9, the primary treatment side (206) is convexly rounded. In addition, each of the first and second lateral sides (210, 212) includes a swept side surface (214) that extends distally along its curved path through a distal portion of the linear blade region (202) and the entire curved blade region (204). As shown in fig. 9, the swept side surface (214) depends downwardly from the circular treatment surface of the primary treatment side (206) and defines a cross-section of the ultrasonic blade (36) having lateral side edges that are substantially parallel to each other.

The blade height of the ultrasonic blade (36) at a selected longitudinal position is defined by a maximum lateral distance measured between the processing side (206) and the cutting edge (208) at the selected position. The blade width of the ultrasonic blade (36) at a selected longitudinal position is defined by a maximum lateral distance measured between the first and second lateral sides (210, 212) at the selected position. As shown in fig. 7 and 8, the curved blade region (204) is shaped such that the blade height is greater than the corresponding blade width at various longitudinal positions therealong, including at the blade tip (76). In other configurations, the knife height may be less than or equal to the knife width.

C. Exemplary configurations of clamping arm electrodes

Fig. 10 shows a schematic cross-sectional end view of a tissue treatment portion of an end effector (22) of a surgical instrument (14) including an ultrasonic blade (36) and a clamp arm (38) having a clamp pad (40). A clamp pad (40) extends distally along a centerline region of a clamp side of the clamp arm (38) and provides a clamp arm electrode (42). The clamp arm electrode (42) includes a first electrode side (280) extending distally along a first lateral side of the clamp pad (40) and a second electrode side (282) extending along an opposite second lateral side of the clamp pad (40). As shown in fig. 10, each clamping arm electrode side (280, 282) is formed to have a lateral electrode width (W) measured from an outer lateral edge of the electrode side (280, 282) to an inner lateral edge of the electrode side (280, 282), showing the corresponding lateral side abutting the clamping pad (40). The clamp pad (40) is formed to have a lateral pad width that is greater than a lateral width of the ultrasonic blade (36) so as to define a lateral gap distance (G1) between an inner lateral edge of each clamp arm electrode side (280, 282) and a corresponding lateral side (210, 212) of the blade (36). The clamping pad (40) protrudes beyond the electrode side (280, 282) in a direction toward the primary treatment side (266) of the knife (36). This configuration defines a vertical gap distance (G2) between each electrode side (280, 282) and the clamping surface of the clamping pad (40) and thus the primary processing side (266) of the knife (36).

The optimal size of the lateral electrode width (W) provides sufficient electrode surface area for delivering bipolar RF energy sufficient to seal tissue while preventing unwanted electrical sparking or arcing due to too small an electrode width (W). Optimal sizing of the gap distances (G1, G2) enables peak efficiency of the end effector (22). For example, the optimal size of the gap distances (G1, G2) prevents unwanted electrical shorting between the ultrasonic blade (36) and the clamp arm (38) due to the gap distances (G1, G2) being too small, and further prevents unwanted electrical sparks or arcing and resulting RF energy transmission inefficiencies due to the gap distances (G1, G2) being too large. In an exemplary configuration, the lateral electrode width (W) of each clamp arm electrode side (280, 282) may be in the range of about 0.007 inches to about 0.018 inches, such as, for example, about 0.018 inches. The lateral gap distance (G1) corresponding to each electrode side (280, 282) may be in the range of about 0.002 inches to about 0.012 inches, such as about 0.007 inches or about 0.012 inches, for example. Additionally, in various examples, the vertical gap distance (G2) corresponding to the electrode sides (280, 282) is greater than 0 and may be uniform and equal to each other along the entire length of the electrode sides (280, 290).

Exemplary variations of the clamp arm (38) and their dimensional configurations are described below, each of which is configured to function in a similar manner as the clamp arm (38) and is adapted for use with a surgical instrument (14). Additionally, the lateral electrode width (W) and gap distance (G1, G2) of the additional clamp arm configurations described below may fall within the exemplary ranges described above. Those skilled in the art will appreciate that various additional variations of the clamp arm (38) incorporating any one or more of the exemplary clamp arm electrode features of the clamp arm described below may be used in combination with the surgical instrument (14).

Fig. 11 shows an end effector (290) including an ultrasonic blade (36) and a clamp arm (292) according to a first exemplary variation of the clamp arm (38) of fig. 10. The clamp arm (292) is similar to the clamp arm (38) in that the clamp arm (292) includes a centrally located clamp pad (294) and first and second clamp arm electrode side portions (296, 298) extending distally along respective lateral sides of the clamp pad (294). The distal ends of the clamp arm electrode sides (296, 298) are joined together by a distal electrode bridge portion (299). As shown, the lateral electrode width (W) of each electrode side (296, 298) is uniform and equal to the other along the entire length of the treatment portion of the ultrasonic blade (36). Similarly, the lateral gap distance (G1) corresponding to each electrode side (296, 298) is uniform and equal to the other along the entire length of the tissue treatment portion of the ultrasonic blade (36). The lateral electrode width W and the lateral gap distance G may fall within the ranges described above.

Fig. 12 shows an end effector (300) including an ultrasonic blade (36) and a clamp arm (302) according to a second exemplary variation of the clamp arm (38) of fig. 10. The clamp arm (302) is similar to the clamp arm (292) of fig. 11 in that the clamp arm (302) includes a centrally located clamp pad (304) and first and second clamp arm electrode sides (306, 308) extending distally along respective lateral sides of the clamp pad (304) and joined at their distal ends by an electrode bridge portion (309). The clamp arm (302) is further similar to the clamp arm (292) in that the lateral electrode width (W) of each electrode side (306, 308) is uniform and equal to the other along the entire length of the tissue treatment portion of the ultrasonic blade (36).

The clamp arm (302) differs from the clamp arm (292) in that the lateral gap distance (G1) of each electrode side (306, 308) is non-uniform along the length of the tissue treatment portion of the knife (36). Specifically, the lateral gap distance (G1) flares or increases distally along a distal portion of the bending region (204) of the knife (36). In the present example, the lateral gap distance (G1) of the electrode side (308) increases distally at a greater rate than the lateral gap distance (G1) of the electrode side (306). Thus, the lateral gap distances (G1) of the electrode sides (306, 308) are not equal to each other throughout the distal portion of the bending region (204) of the blade (36). Specifically, the lateral gap distance (G1) of the electrode side (308) is greater than the lateral gap distance (G1) of the electrode side (306) at various longitudinal positions along the bending region (204) of the blade (36). In other variations of the clamp arm (302), the lateral gap distance (G1) of the electrode sides (306, 308) may increase distally at the same rate such that the gap distances (G1) remain equal to each other throughout the curved knife region (204).

As shown in fig. 12, the configuration of the clamp arm (302) described above may be achieved by providing the clamp pad (304) with a width that flares or increases laterally outward through the distal portion of the curved blade region (204). The increased gap distance (G1) at the distal portion of the end effector (300), where lateral deflection of the ultrasonic blade (36) is greatest, allows for greater lateral misalignment between the ultrasonic blade (36) and the clamp arm (302) while maintaining electrical coupling therebetween through the clamped tissue. In order to maintain a uniform lateral electrode width (W) throughout the flared region of the clamp pad (304), the lateral width of the clamp arm (302) increases or flares distally concurrently with the lateral width of the clamp pad (304).

Fig. 13 shows an end effector (310) including an ultrasonic blade (36) and a clamp arm (312) according to a third exemplary variation of the clamp arm (38) of fig. 10. Clamp arm (312) is similar to clamp arm (302) of fig. 12 in that clamp arm (312) includes a centrally located clamp pad (314) and first and second clamp arm electrode sides (316, 318) extending distally along respective lateral sides of clamp pad (314) and joined at their distal ends by an electrode bridge portion (319). The clamp arm (312) is further similar to the clamp arm (302) in that the lateral gap distance (G1) of each electrode side (316, 318) increases distally along the distal portion of the curved blade region (204), and the gap distances (G1) are not equal to each other at all longitudinal positions throughout the curved blade region (204).

The clamp arm (312) differs from the clamp arm (302) in that the lateral electrode width (W) of each electrode side (316, 318) is non-uniform along the length of the tissue treatment portion of the blade (36). Specifically, the lateral electrode width (W) tapers or decreases distally along a distal portion of the curved blade region (204). In other words, as the lateral gap distance (G1) increases, the lateral electrode width (W) decreases. The rates of increase and decrease may be similar to each other. Additionally, the lateral electrode widths (W) of the electrode sides (316, 318) may be substantially equal to each other at any given longitudinal position along the clamp arm (312). The narrower electrode sides (316, 318) of the clamp arm (302) deliver a concentrated level of bipolar RF energy at the clamp arm segments with increased gap distance (G1). This enables efficient delivery of electrosurgical bipolar RF energy to tissue at large gap segments that accommodate a large degree of lateral deflection of the ultrasonic blade (36) as described above, without the need to splay the lateral width of the clamp arm (312) outward like the clamp arm (302) of fig. 12. Thus, the clamp arm (312) may generally provide the same performance benefits as the clamp arm (302) while maintaining a slimmer profile.

Fig. 14 shows an end effector (320) including an ultrasonic blade (36) and a clamp arm (322) according to a fourth exemplary variation of the clamp arm (38) of fig. 10. The clamp arm (322) is similar to the clamp arms (292, 302, 312) described above in that the clamp arm (322) includes a centrally located clamp pad (324) and first and second clamp arm electrode sides (326, 328) extending distally along respective lateral sides of the clamp pad (324). In addition, the lateral electrode width (W) of each electrode side (326, 328) is uniform and equal to the other along the entire length of the tissue treatment portion of the ultrasonic blade (36).

The clamp arm (322) differs from the clamp arm (292, 302, 312) in that the clamp arm (322) omits a distal electrode bridge portion that engages the distal end (327, 329) of the electrode side (326, 328). In contrast, in the present example, the electrode distal ends (327, 329) are laterally separated from each other by a clamping pad (324) that extends to the distal tip of the clamping arm (322). Further, the electrode distal tips (327, 329) are aligned with the distal blade tip (76), but it should be understood that in other examples, the distal ends (327, 329) may terminate proximal or distal to the blade tip (76). Although not shown, a variation of any of the clamp arms (292, 302, 312) described above may be provided in which the distal electrode bridge portion (299, 309, 319) is omitted to provide an electrode distal end similar to the distal ends (327, 329) of the clamp arm (322).

Each clamping arm (292, 302, 312, 322) as described above has a first electrode side and a second electrode side having a width (W) equal to each other along the entire length of the electrode sides. However, alternative variations of the clamping arms (292, 302, 312, 322) may have electrode sides that are unequal in width (W) along one or more longitudinally extending portions thereof (e.g., along portions corresponding to the curved blade region (204)). Such variations in electrode width (W) may be provided to accommodate performance differences exhibited by the blade (36) and/or clamp arm (292, 302, 312, 322) between its concavely curved lateral side corresponding to the first lateral blade side (210) and its corresponding convexly curved lateral side corresponding to the second lateral blade side (212). For example, during use, concavely curved lateral sides of the knife (36) and clamp arms (292, 302, 312, 322) may provide a first degree of cutting and sealing treatment to tissue, while convexly curved lateral sides of the knife (36) and clamp arms (292, 302, 312, 322) may provide a second degree of cutting and sealing treatment to tissue.

Exemplary combinations

The following examples relate to various non-exhaustive ways in which the teachings herein may be combined or applied. It should be understood that the following examples are not intended to limit the scope of coverage of any claims that may be presented at any time in this patent application or in subsequent filing of this patent application. Disclaimer is not intended. The following examples are provided for illustrative purposes only. It is contemplated that the various teachings herein may be arranged and applied in a variety of other ways. It is also contemplated that some variations may omit certain features mentioned in the following embodiments. Thus, none of the aspects or features mentioned below should be considered critical unless explicitly indicated otherwise, e.g., by the inventors or successors to the inventors at a later date. If any claim made in this patent application or in a subsequent filing document related to this patent application includes additional features beyond those mentioned below, then these additional features should not be assumed to be added for any reason related to patentability.

Example 1

A surgical instrument, comprising: (a) an ultrasonic transducer; (b) a shaft extending distally relative to the ultrasound transducer; and (c) an end effector disposed at the distal end of the shaft, wherein the end effector comprises: (i) an ultrasonic blade configured to be driven with ultrasonic energy by the ultrasonic transducer, wherein the ultrasonic blade comprises: (A) an upper treatment side, (B) a lower treatment side disposed opposite the upper treatment side, (C) a first lateral side, and (D) a second lateral side disposed opposite the first lateral side, and (ii) a clamp arm movable relative to the ultrasonic blade for clamping tissue therebetween, wherein the clamp arm provides an RF electrode operable to seal tissue with RF energy, wherein the RF electrode comprises: (A) a first electrode side, wherein the first electrode side is laterally spaced outward from the first lateral side of the ultrasonic blade by a first lateral gap distance; and (B) a second electrode side spaced apart from the first electrode side, wherein the second electrode side is spaced laterally outward from the second lateral side of the ultrasonic blade by a second lateral gap distance.

Example 2

The surgical instrument of embodiment 1, wherein the end effector further comprises a clamp pad coupled to the clamp arm, wherein the first electrode side extends along a first lateral side of the clamp pad, wherein the second electrode side extends along a second lateral side of the clamp pad.

Example 3

The surgical instrument of any of the preceding embodiments, wherein the first lateral gap distance is equal to the second lateral gap distance along the curved distal portion of the ultrasonic blade.

Example 4

The surgical instrument of any of the preceding embodiments, wherein at least one of the first lateral gap distance or the second lateral gap distance is uniform along the curved distal portion of the ultrasonic blade.

Example 5

The surgical instrument of any of the preceding embodiments, wherein at least one of the first lateral gap distance or the second lateral gap distance is non-uniform along the curved distal portion of the ultrasonic blade.

Example 6

The surgical instrument of any of the preceding embodiments, wherein each of the first and second lateral gap distances is in the range of 0.002 to 0.012 inches along the curved distal portion of the ultrasonic blade.

Example 7

The surgical instrument of any preceding embodiment, wherein a lateral width of at least one of the first electrode side or the second electrode side is uniform along a length of at least a distal portion of the clamping arm.

Example 8

The surgical instrument of any preceding embodiment, wherein a lateral width of at least one of the first electrode side or the second electrode side is non-uniform along a length of at least a distal portion of the clamping arm.

Example 9

The surgical instrument of embodiment 8, wherein the lateral width of at least one of the first electrode side or the second electrode side increases distally.

Example 10

The surgical instrument of any of embodiments 8-9, wherein the lateral width of at least one of the first electrode side or the second electrode side decreases distally.

Example 11

A surgical instrument as in any preceding embodiment, wherein a lateral width of each of the first and second electrode sides is in a range of 0.007 inches to 0.018 inches along a length of at least a distal portion of the clamp arm.

Example 12

The surgical instrument of any one of the preceding embodiments, wherein the RF electrode extends distally beyond a distal tip of the ultrasonic blade and defines an electrode bridge portion that electrically couples the distal end of the first electrode side with the distal end of the second electrode side.

Example 13

The surgical instrument of any of the preceding embodiments, wherein the ultrasonic blade comprises a linear proximal portion and a curved distal portion, wherein the first electrode side and the second electrode side extend alongside the curved distal portion.

Example 14

The surgical instrument of any of the preceding embodiments, wherein the RF electrode comprises a first RF electrode, wherein the ultrasonic blade provides a second RF electrode, wherein the first RF electrode and the second RF electrode are operable to seal tissue with bipolar RF energy.

Example 15

The surgical instrument of any of the preceding embodiments, wherein the upper treatment side of the ultrasonic blade comprises a convexly curved surface that provides the second RF electrode.

Example 16

A surgical instrument, comprising: (a) an ultrasonic transducer; (b) a shaft extending distally relative to the ultrasound transducer; and (c) an end effector disposed at the distal end of the shaft, wherein the end effector comprises: (i) an ultrasonic blade configured to be driven with ultrasonic energy by the ultrasonic transducer, wherein the ultrasonic blade comprises: (A) an upper treatment side, (B) a lower treatment side disposed opposite the upper treatment side, (C) a first lateral side, and (D) a second lateral side disposed opposite the first lateral side, and (ii) a clamp arm movable relative to the ultrasonic blade for clamping tissue therebetween, wherein the clamp arm provides an RF electrode operable to seal tissue with RF energy, wherein the RF electrode comprises: (A) a first electrode side, wherein the first electrode side has a first width and is laterally spaced outward from the first lateral side of the ultrasonic blade by a first lateral gap distance; and (B) a second electrode side spaced apart from the first electrode side, wherein the second electrode side has a second width and is laterally spaced outward from the second lateral side of the ultrasonic blade by a second lateral gap distance, wherein at least one of the first width or the second width is non-uniform along a length of at least a distal portion of the clamp arm, wherein at least one of the first lateral gap distance or the second lateral gap distance is non-uniform along the length of at least the distal portion of the clamp arm.

Example 17

The surgical instrument of embodiment 16, wherein each of the first and second widths decreases distally.

Example 18

The surgical instrument of any of embodiments 16-17, wherein each of the first and second lateral gap distances increases distally.

Example 19

A surgical instrument, comprising: (a) an ultrasonic transducer; (b) a shaft extending distally relative to the ultrasound transducer; and (c) an end effector disposed at the distal end of the shaft, wherein the end effector comprises: (i) an ultrasonic blade configured to be driven with ultrasonic energy by the ultrasonic transducer, wherein the ultrasonic blade comprises: (A) a linear proximal blade portion, (B) a curved distal blade portion, (C) a first lateral side, and (D) a second lateral side disposed opposite the first lateral side, and (ii) a clamp arm movable relative to the ultrasonic blade for clamping tissue therebetween, wherein the clamp arm provides an RF electrode operable to seal tissue with RF energy, wherein the RF electrode comprises: (A) a first electrode side, wherein the first electrode side is laterally spaced outward from the first lateral side of the ultrasonic blade by a first lateral gap distance; and (B) a second electrode side spaced apart from the first electrode side, wherein the second electrode side is spaced laterally outward from the second lateral side of the ultrasonic blade by a second lateral gap distance, wherein at least one of the first lateral gap distance or the second lateral gap distance is in the range of 0.002 inches to 0.012 inches along the curved distal blade portion.

Example 20

The surgical instrument of embodiment 19, wherein a lateral width of at least one of the first electrode side or the second electrode side is in a range of 0.007 inches to 0.018 inches along the curved distal blade portion.

Miscellaneous items

It is to be understood that any one or more of the teachings, expressions, embodiments, examples, etc. described herein can be combined with any one or more of the other teachings, expressions, embodiments, examples, etc. described herein. Accordingly, the above teachings, expressions, embodiments, examples, etc. should not be considered in isolation from each other. Various suitable ways in which the teachings herein may be combined will be apparent to those of ordinary skill in the art in view of the teachings herein. Such modifications and variations are intended to be included within the scope of the claims.

Additionally, any one or more of the teachings, expressions, embodiments, examples, etc. described herein may be combined with any one or more of the teachings, expressions, embodiments, examples, etc. described in the following patent applications: U.S. patent application entitled Combination Ultrasonic and electric instruments With Shared Return Path filed on even date herewith [ attorney docket number END8245USNP ]; U.S. patent application entitled "Combination Ultrasonic and electric measuring Instrument measuring device Having measuring slide Ring electric Contact Assembly" filed on the same day as the above [ attorney docket No. END8245USNP1 ]; U.S. patent application entitled Combination ultrasound and electronic Instrument instruments incorporated features filed on even date herewith [ attorney docket number END8245USNP2 ]; U.S. patent application entitled Combination ultrasound and electronic Instrument cutting Blade filed on even date herewith [ attorney docket number END8245USNP3 ]; U.S. patent application entitled Combination Ultrasonic and electronic Instrument Having multiple over move Member filed on even date herewith [ attorney docket number END8245USNP5 ]; U.S. patent application entitled Combination ultrasound and electronic System wavelength Generator Filter Circuit filed on even date herewith [ attorney docket No. END8245USNP6 ]; and/or U.S. patent application entitled Combination ultrasound and electronic System height EEPROM and ASIC Components filed on even date herewith [ attorney docket number END8245USNP7 ]. The disclosure of each of these applications is incorporated herein by reference.

Additionally, any one or more of the teachings, expressions, embodiments, examples, etc. described herein may be combined with any one or more of the teachings, expressions, embodiments, examples, etc. described in the following patent applications: U.S. patent application entitled Combination ultrasound and electronic Instrument Position Input and Method for Identifying Tissue State filed on even date herewith [ attorney docket number END8146USNP ]; U.S. patent application attorney docket number [ END8146USNP1] entitled Combination ultrasound and electronic Instrument with Adjustable Energy modules and Method for sealing and Inhibiting Tissue selection filed on even date herewith; U.S. patent application entitled Combination ultrasound and electronic Instrument with Adjustable Clamp Force and Related Methods filed on even date herewith [ attorney docket No. END8146USNP2 ]; U.S. patent application entitled Combination Ultrasonic and electronic Instrument with Adjustable Energy Modular Method for Limiting Blade Temperature filed on even date herewith [ attorney docket number END8146USNP3 ]; U.S. patent application attorney docket number END8146USNP4 entitled Combination ultrasound and electronic Instrument and Method for Sealing with variable termination Parameters, filed on even date herewith; and/or U.S. patent application entitled Combination Ultrasonic and electrolytic instruments and methods for Sealing Tissue in successful Phases filed on even date herewith [ attorney docket number END8146USNP5 ]. The disclosure of each of these applications is incorporated herein by reference.

It should be understood that any patent, patent publication, or other disclosure material, in whole or in part, that is said to be incorporated by reference herein is incorporated herein only to the extent that the incorporated material does not conflict with existing definitions, statements, or other disclosure material set forth in this disclosure. Thus, and to the extent necessary, the disclosure as explicitly set forth herein supersedes any conflicting material incorporated herein by reference. Any material, or portion thereof, that is said to be incorporated by reference herein, but which conflicts with existing definitions, statements, or other disclosure material set forth herein will only be incorporated to the extent that no conflict arises between that incorporated material and the existing disclosure material.

Versions of the above described apparatus may be used in traditional medical treatments and procedures performed by medical professionals, as well as in robotic-assisted medical treatments and procedures. By way of example only, the various teachings herein may be readily incorporated into a robotic Surgical system, such as davinc (r) of intelligent Surgical, Inc (Sunnyvale, California)^TMProvided is a system. Similarly, one of ordinary skill in the art will recognize that the various teachings herein can be readily combined with the various teachings of any of the following patents: U.S. Pat. No. 5,792,135 entitled "Integrated Surgical Instrument for Performance minimum aware With Enhanced sensitivity and sensitivity", published 11/8/1998, the disclosure of which is incorporated herein by reference; U.S. patent 5,817,084 entitled "Remote Center Positioning Device with Flexible Drive" published on 6.10.1998, the disclosure of which is incorporated herein by reference; U.S. Pat. No. 5,878,193 entitled "Automated Endoscope System for Optimal Positioning", published 3/2 1999, the disclosure of which is incorporated herein by reference; U.S. Pat. No.6,231,565, issued on 5/15/2001 and entitled "Robotic Arm DLUS for performing surgical Tasks", the disclosure of which is incorporated herein by reference; U.S. Pat. No.6,783,524 issued on 31/8/2004 under the name "fibrous Surgical Tool with ultrasonic machining and cutting Instrument", the disclosure of which is incorporated herein by reference; U.S. Pat. No.6,364,888, entitled "Alignment of Master and Slave in a miniature inactive scientific apparatus", published 2002, 4, 2, the disclosure of which is incorporated herein by reference; U.S. Pat. No.7,524,320 entitled "Mechanical Actuator Interface System for Robotic scientific Tools" published on 28.4.2009, the disclosure of which is incorporated herein by reference; the name "Platfo" published in 2010 at 4/6/2010rm Link wriist Mechanism, "U.S. patent 7,691,098, the disclosure of which is incorporated herein by reference; U.S. Pat. No.7,806,891 entitled "replication and registration of Master/Slave relationship in minimum investment Telesurgery", published on 5.10.2010, the disclosure of which is incorporated herein by reference; U.S. patent 8,844,789 entitled "Automated End efficiency assembling System for Use with a road System," published 30/9/2014, the disclosure of which is incorporated herein by reference; U.S. patent 8,820,605 entitled "Roboticaly-Controlled surgical instruments" published on 2.9.2014, the disclosure of which is incorporated herein by reference; U.S. Pat. No.8,616,431 entitled "Shiftable Drive Interface for Roboticality-Controlled Surgicol" published 31/12/2013, the disclosure of which is incorporated herein by reference; U.S. Pat. No.8,573,461 entitled "scientific sampling Instruments with Cam-drive batch DesploymentAreanges" published on 11/5/2013, the disclosure of which is incorporated herein by reference; U.S. Pat. No.8,602,288 entitled "Robotically-Controlled Motorized surgery End Effect System with Rotarily influenced Closure Systems Having Variable action Speeds" published on 12/10 2013, the disclosure of which is incorporated herein by reference; U.S. Pat. No.9,301,759 entitled "Roboticall-Controlled Surgical Instrument with Selective engineering end Effect" published on 5.4.2016, the disclosure of which is incorporated herein by reference; U.S. patent 8,783,541 entitled "Roboticaly-Controlled Surgical End Effect System," published 22/7/2014, the disclosure of which is incorporated herein by reference; U.S. patent 8,479,969 entitled "Drive interface for operating Coupling a regulatory Surgical Tool to a Robot" published on 7/9/2013, the disclosure of which is incorporated herein by reference; U.S. patent publication 8,800,838 entitled "Roboticaly-Controlled Cable-Based Surgical End effects," published 12/8/2014, the disclosure of which is incorporated herein by reference; and/or a name "Roboticality-controlledSurgical" published on 11/5/2013U.S. Pat. No.8,573,465 to al End effect System with road acquired close Systems ", the disclosure of which is incorporated herein by reference.

Devices of the type described above may be designed to be disposed of after a single use, or they may be designed to be used multiple times. In either or both cases, these versions can be reconditioned for reuse after at least one use. The repair may include any combination of the following steps: disassembly of the device, followed by cleaning or replacement of particular parts and subsequent reassembly. In particular, some versions of the device may be disassembled, and any number of the particular pieces or parts of the device may be selectively replaced or removed in any combination. Upon cleaning and/or replacement of particular components, some versions of the device may be reassembled for subsequent use either at a reconditioning facility, or by a user immediately prior to a procedure. Those skilled in the art will appreciate that reconditioning of a device can utilize a variety of techniques for disassembly, cleaning/replacement, and reassembly. The use of such techniques and the resulting prosthetic devices are within the scope of the present application.

By way of example only, versions described herein may be sterilized before and/or after surgery. In one sterilization technique, the device is placed in a closed and sealed container such as a plastic or TYVEK bag. The container and device may then be placed in a field of radiation that can penetrate the container, such as gamma radiation, x-rays, or high energy electrons. The radiation may kill bacteria on the device and in the container. The sterilized device may then be stored in a sterile container for later use. The device may also be sterilized using any other technique known in the art, including but not limited to beta or gamma radiation, ethylene oxide, or steam.

While various embodiments of the present invention have been shown and described, further modifications of the methods and systems described herein may be accomplished by appropriate modifications by one of ordinary skill in the art without departing from the scope of the present invention. Several such possible modifications have been mentioned, and other modifications will be apparent to those skilled in the art. For example, the examples, embodiments, geometries, materials, dimensions, ratios, steps, etc., discussed above are illustrative and not required. The scope of the invention should, therefore, be considered in terms of the following claims and is understood not to be limited to the details of structure and operation shown and described in the specification and drawings.

Claims

1. A surgical instrument, comprising:

(a) an ultrasonic transducer;

(b) a shaft extending distally relative to the ultrasound transducer; and

(c) an end effector disposed at a distal end of the shaft, wherein the end effector comprises:

(i) an ultrasonic blade configured to be driven with ultrasonic energy by the ultrasonic transducer, wherein the ultrasonic blade comprises:

(A) the upper part of the processing side is provided with a processing side,

(B) a lower process side disposed opposite the upper process side,

(C) a first lateral side, and

(D) a second lateral side disposed opposite to the first lateral side, an

(ii) A clamp arm movable relative to the ultrasonic blade for clamping tissue therebetween, wherein the clamp arm provides an RF electrode operable to seal tissue with RF energy, wherein the RF electrode comprises:

(A) a first electrode side, wherein the first electrode side is laterally spaced outward from the first lateral side of the ultrasonic blade by a first lateral gap distance; and

(B) a second electrode side spaced apart from the first electrode side, wherein the second electrode side is spaced laterally outward from the second lateral side of the ultrasonic blade by a second lateral gap distance.

2. The surgical instrument of claim 1, wherein the end effector further comprises a clamp pad coupled to the clamp arm, wherein the first electrode side extends along a first lateral side of the clamp pad, wherein the second electrode side extends along a second lateral side of the clamp pad.

3. The surgical instrument of claim 1, wherein the first lateral gap distance is equal to the second lateral gap distance along the curved distal portion of the ultrasonic blade.

4. The surgical instrument of claim 1, wherein at least one of the first lateral gap distance or the second lateral gap distance is uniform along a curved distal portion of the ultrasonic blade.

5. The surgical instrument of claim 1, wherein at least one of the first lateral gap distance or the second lateral gap distance is non-uniform along a curved distal portion of the ultrasonic blade.

6. The surgical instrument of claim 1, wherein each of the first and second lateral gap distances is in a range of 0.002 to 0.012 inches along the curved distal portion of the ultrasonic blade.

7. The surgical instrument of claim 1, wherein a lateral width of at least one of the first electrode side or the second electrode side is uniform along a length of at least a distal portion of the clamp arm.

8. The surgical instrument of claim 1, wherein a lateral width of at least one of the first electrode side or the second electrode side is non-uniform along a length of at least a distal portion of the clamp arm.

9. The surgical instrument of claim 8, wherein the lateral width of at least one of the first electrode side or the second electrode side increases distally.

10. The surgical instrument of claim 8, wherein the lateral width of at least one of the first electrode side or the second electrode side decreases distally.

11. The surgical instrument of claim 1, wherein a lateral width of each of the first and second electrode sides is in a range of 0.007 inches to 0.018 inches along a length of at least a distal portion of the clamp arm.

12. The surgical instrument of claim 1, wherein the RF electrode extends distally beyond a distal tip of the ultrasonic blade and defines an electrode bridge portion that electrically couples a distal end of the first electrode side with a distal end of the second electrode side.

13. The surgical instrument of claim 1, wherein the ultrasonic blade comprises a linear proximal portion and a curved distal portion, wherein the first and second electrode sides extend alongside the curved distal portion.

14. The surgical instrument of claim 1, wherein the RF electrode comprises a first RF electrode, wherein the ultrasonic blade provides a second RF electrode, wherein the first and second RF electrodes are operable to seal tissue with bipolar RF energy.

15. The surgical instrument of claim 14, wherein the upper treatment side of the ultrasonic blade comprises a convexly curved surface that provides the second RF electrode.

16. A surgical instrument, comprising:

(a) an ultrasonic transducer;

(b) a shaft extending distally relative to the ultrasound transducer; and

(c) an end effector disposed at a distal end of the shaft,

wherein the end effector comprises:

(A) the upper part of the processing side is provided with a processing side,

(B) a lower process side disposed opposite the upper process side,

(C) a first lateral side, and

(D) a second lateral side disposed opposite to the first lateral side, an

(A) a first electrode side, wherein the first electrode side has a first width and is laterally spaced outward from the first lateral side of the ultrasonic blade by a first lateral gap distance; and

(B) a second electrode side spaced apart from the first electrode side, wherein the second electrode side has a second width and is spaced laterally outward from the second lateral side of the ultrasonic blade by a second lateral gap distance,

wherein at least one of the first width or the second width is non-uniform along a length of at least a distal portion of the clamp arm,

wherein at least one of the first lateral gap distance or the second lateral gap distance is non-uniform along the length of at least the distal portion of the clamp arm.

17. The surgical instrument of claim 16, wherein each of the first and second widths decreases distally.

18. The surgical instrument of claim 16, wherein each of the first and second lateral gap distances increases distally.

19. A surgical instrument, comprising:

(a) an ultrasonic transducer;

(b) a shaft extending distally relative to the ultrasound transducer; and

(c) an end effector disposed at a distal end of the shaft,

wherein the end effector comprises:

(A) a linear proximal blade portion having a proximal blade portion,

(B) the distal blade portion is bent such that it is,

(C) a first lateral side, and

(D) a second lateral side disposed opposite to the first lateral side, an

(B) a second electrode side spaced apart from the first electrode side, wherein the second electrode side is spaced laterally outward from the second lateral side of the ultrasonic blade by a second lateral gap distance,

wherein at least one of the first lateral gap distance or the second lateral gap distance is in a range of 0.002 inches to 0.012 inches along the curved distal blade portion.

20. The surgical instrument of claim 19, wherein a lateral width of at least one of the first electrode side or the second electrode side is in a range of 0.007 inches to 0.018 inches along the curved distal blade portion.